Objective     To evaluate the predictive performance of the geometric characteristics, centerline (CL) of pulmonary nodules for prognosis in patients with surgically treatment in the National Lung Screening Trial (NLST). Methods    CT images of 178 patients who underwent surgical treatment and were diagnosed with non-small cell lung cancer (NSCLC) in the low-dose CT (LDCT) cohort from the NLST image database were selected, including 99 males and 79 females, with a median age of 64 (59, 68) years. CT images were processed using commercial software Mimics 21.0 to record the volume, surface area, CL and the area perpendicular to the centerline of pulmonary nodules. Receiver operating characteristic (ROC) curve was used to compare the predictive performance of LD, AD and CL on prognosis. Univariate Cox regression was used to explore the influencing factors for postoperative disease-free survival (DFS) and overall survival (OS), and meaningful independent variables were included in the multivariate Cox regression to construct the prediction model. Results    The area under the curve (AUC) of CL for postoperative recurrence and death were 0.650 and  0.719, better than LD (0.596, 0.623) and AD (0.600, 0.631). Multivariate Cox proportional risk regression analysis showed that pulmonary nodule volume (P=0.010), the maximum area perpendicular to the centerline (MApc)(P=0.028) and lymph node metastasis (P<0.001) were independent risk factors for DFS. Meanwhile, age (P=0.010), CL (P=0.043), lymph node metastasis (P<0.001), MApc (P=0.022) and the average area perpendicular to the centerline (AApc) (P=0.016) were independently associated with OS. Conclusion    For the postoperative outcomes of NSCLC patients in the LDCT cohort of the NLST, the CL of the pulmonary nodule prediction performance for prognosis is superior to the LD and AD, CL can effectively predict the risk stratification and prognosis of lung cancer, and spheroid tumors have a better prognosis.

Objective:To understand the cognition and attitudes of Emergency Department nurses towards palliative care, and to explore the factors that hinder or promote the development of palliative care in the Emergency Department, so as to provide basic data for emergency palliative care.Methods:From March to June 2021, semi-structured interviews were conducted with 11 nurses in the Emergency Department of Peking Union Medical College Hospital using the purposeful sampling. The interview data were organized and analyzed using Colaizzi's 7-step analysis method.Results:A total of three themes were induced. The themes were that Emergency Department patients and their families were often caught in decision-making dilemmas, and Emergency Department nurses had a high degree of acceptance of palliative care, but there were barriers to implementation in the Emergency Department, and the implementation methods of emergency palliative care needed to be further explored, and Emergency Department nurses were willing to participate in palliative care training.Conclusions:Emergency palliative care needs to consider the characteristics of the Emergency Department work environment and explore appropriate implementation methods. Training related to palliative care can be increased, the palliative care literacy of Emergency Department nurses can be improved, so as to provide effective support for life-limited patients and their families.

Objective:To understand the cognition and attitudes of Emergency Department nurses towards palliative care, and to explore the factors that hinder or promote the development of palliative care in the Emergency Department, so as to provide basic data for emergency palliative care.Methods:From March to June 2021, semi-structured interviews were conducted with 11 nurses in the Emergency Department of Peking Union Medical College Hospital using the purposeful sampling. The interview data were organized and analyzed using Colaizzi's 7-step analysis method.Results:A total of three themes were induced. The themes were that Emergency Department patients and their families were often caught in decision-making dilemmas, and Emergency Department nurses had a high degree of acceptance of palliative care, but there were barriers to implementation in the Emergency Department, and the implementation methods of emergency palliative care needed to be further explored, and Emergency Department nurses were willing to participate in palliative care training.Conclusions:Emergency palliative care needs to consider the characteristics of the Emergency Department work environment and explore appropriate implementation methods. Training related to palliative care can be increased, the palliative care literacy of Emergency Department nurses can be improved, so as to provide effective support for life-limited patients and their families.

Objective: To investigate the clinical relevance of mannose-binding lectin 2 (MBL2) gene polymorphism with traumatic sepsis in Hainan Province. Methods: A retrospective case control study was conducted to analyze the clinical data of 112 severe trauma patients admitted to the First Affiliated Hospital of Hainan Medical College and Haikou People's Hospital from June 2017 to June 2018. There were 73 males and 39 females, aged 17-83 years [(41.8±8.9)years]. There were 48 patients in the sepsis group and 64 patients in the non-sepsis group. Multiplex single nucleotide extension polymorphism (SNaPshot) typing technique was used to detect the MBL2 gene polymorphism. The correlation between different genotypes and the risk of sepsis was analyzed. ELISA method was used to detect the level of MBL2 in plasma of each group. Results: Among the three polymorphic loci of MBL2 gene (rs5030737, rs1800450 and rs1800451), the mutation frequency of rs1800450 was 27.7%, while the mutation frequency of rs5030737 and of rs1800451 was 0. The genotype distribution in two groups was in accordance with Hardy-Weinberg equilibrium. The frequency of GA genotype in sepsis group was significantly higher than that in non-sepsis group (P<0.05). A allele frequency in sepsis group was also much higher than that in non-sepsis group (P<0.05). Patients with GA genotype had increased risk of traumatic sepsis when compared to GG genotype(OR=3.442, 95%CI 1.447-8.187). Allele A increased the prevalence of sepsis significantly as well when compared to allele G(OR=2.799, 95%CI 1.270-6.170). The MBL2 level in serum in sepsis patients with genotype GG and GA was significantly lower than that in non-sepsis group (P<0.05). In sepsis group, the MBL2 serum level of patients with genotype GA was obviously lower than that in patients with genotype GG (P<0.05). Conclusion MBL2 rs1800450G/A polymorphism is closely related to the occurrence of sepsis in Hainan province, and may be related to the decrease of serum MBL2 level in patients with mutant type.

Objective? To investigate the current status and influencing factors on career decision-making self-efficacy among near-employment internship nursing students. Methods? By convenience sampling, the near-employment internship nursing students who voluntarily participant in this research were selected from April to May of 2018 from a ClassⅢ Grade A hospital in Beijing. The Career Decision-Making Self-Efficacy Scale (CDMSE) was used in the study to investigate the participants. A total of 178 questionnaires were distributed with 170 valid ones retrieved. Results? The total score of CDMSE of 170 near employment internship nursing students was (137.62±2.240). The linear-regression analysis showed that gender and satisfaction on hospitals were the influencing factors of their career decision-making self-efficacy. Conclusions? The career decision-making self-efficacy of internship nursing students is at an intermediate level. Hospitals and schools can develop individualized training methods for them in order to improve their career decision-making self-efficacy.

Objective? To understand the psychological experience of nursing interns who underwent bedside rescue events. Methods? From September to December of 2018, 12 nursing interns who underwent bedside rescue events in Rescue Room of Emergency Department were interviewed and data was processed by Colaizzi 7-step analysis method. Results? Totally five themes were extracted: novelty and overwhelming, orderly rescue work caused the nursing interns to think about their own value, the sense of value due to professional identity, solid basic skills and reasonable teaching is the cornerstone of the rescue room internship, and the perception of sense of mission. Conclusions? Schools and hospitals should pay attention to the cultivation of soft skills of nursing interns, improve the familiarity of nursing interns with first-aid equipment, consolidate their basic skills, and establish a standardized first-aid process to improve the teaching work to foster first-aid awareness of nursing interns and promote nursing students to integrate into the rescue environment.

Objective To investigate the role of large-diameter magnetic resonance imaging (MRI) simulation in target volume delineation in radiotherapy for nasopharyngeal carcinoma (NPC).Methods Eighteen patients with NPC underwent computed tomography (CT) simulation and MRI simulation scans and localization in the same body position,with SOMATOM Sensation Open 40-row 82-cm large-diameter CT simulator and Siemens 3T MRI MAGNETOM Skyra 70-cm large-diameter simulator,respectively.The gross tumor volume (GTV) and parotid glands were delineated on all images according to the ICRU Report 50/62,and MRI was applied to observe the changes in GTV and parotid volume during radiotherapy.Paired t-test was applied to analyze the differences between GTVCT and GTVMRI and between GTVnx-CT and GTVnx-MRI.Results GTVMRI decreased significantly compared with GTVCT,and the average volume decreased from (213.64±84.59) cm3 to (199.68±84.69) cm3(p=0.006).As for the volume of primary lesions in the nasopharynx,GTVnx-MRI was significantly smaller than GTVnx-CT,and the volume decreased from (95.75± 24.76) cm3 to (88.12±26.25) cm3 (P =0.001);as for the volume of cervical lymph nodes,GTVnd-MRI was significantly smaller than GTVnd-CT,and the volume decreased from (117.89± 72.69) cm3 to (111.56± 70.69) cm3 (P=0.018).The targets delineated by CT and MRI did not overlap completely,with major differences in skull base bone and cervical soft tissue.The volume of both parotid glands delineated on MRI image was higher than that delineated on CT image,with a major difference in the deep lobe.MRI showed that GTV was reduced by 82.64± 16.87％ during radiotherapy,and the volumes of the left and right parotid glands were reduced by (32.7± 23.95) ％ and (34.7± 21.72) ％,respectively.Conclusions The delineation of target volume based on MRI simulation is more accurate than that based on CT simulation and can achieve a smaller volume range,which helps to guide target volume delineation in radiotherapy for NPC accurately.

Objective To evaluate the value and significance of bedside ultrasound in diagnosis of lung atelectasis/consolidation in multiple trauma patients with mechanical ventilation.Methods Bedside thoracic ultrasound and chest computed tomography(CT)were performed in 81 multiple trauma patients with mechanical ventilation admitted to the emergency intensive care unit(EICU).CT result was regarded as the "golden standard" to evaluate the value of ultrasound in diagnose lung atelectasis/consolidation.At the same time,the ultrasound was used to dynamically monitor the lung recruitment effect of the therapeutic measures.Results CT detected 154 regions of lung atelectasis/consolidation of 324 lung regions in 81 patients,while ultrasound detected 126 regions that were divided into 87 complete regions and 39 incomplete regions according to different sonogram in the breathing cycle.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of ultrasound were 81.8%,100%,100%,85.9% and 91.4% respectively.A concordance test showed a very high concordance between ultrasound and CT,with a Kappa coefficient of 0.825(P=0.031).Ultrasound found that 39 regions with incomplete lung atelectasis/consolidation were completely recruited and 62 out of 87 regions with complete lung atelectnsis/eonsolidatian gained visible recruitment within three days after different therapeutic measures,with total effective rate of 80.2%.Conclusion Bedside ultrasound can continuously monitor and guide the therapeutic measure to recruit the lung and is a convenient,safe,direct-viewing and accurate method for diagnosis of lung atelectasis/cansolidation in multiple trauma patients with mechanical ventilation.

This article mainly expounded the actuality,the importance and the improving way of enhancing the western rural education.

The expression, amplification and rearrangement of c-myc and c-erbB-2 genes in thyroid tumor were studied. 32P-dATP-labelled probes of c-myc, c-erbB-2 and v-sis DNA fragments were used to hybridise with the cellular total RNA. We found that c-myc and c-erbB-2 oncogenes were expressed in all samples. The levels of c-myc RNA were three-to eleven-fold higher in 9 out of 15 cancer samples when compared with that in normal tissues. In 7 of 15 cancer samples, c-erbB-2 gene was overexpressed 10~50 times higher than normal. No v-sis RNA was detected in all the samples. Southern blot hybridisation showed that rearrangement of c-myc oncogene were observed in 4 cancer samples, of which one showed a 150-fold amplification of c-myc gene. No amplification or rearrangement of c-erbB-2 gene was detected. These data indicate that the activat.:on of c-myc and c-erbB-2 oncogenes may contribute to the development and/or maintenance of the malignant phenotype of the thyroid carcinomas.